BMC Neurology最新文献

Objective: To investigate the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) in Parkinson's disease (PD) patients with mild cognitive impairment (MCI).

Methods: This was a randomized, double-blind, controlled study. We consecutively enrolled PD patients with MCI (PD-MCI) from the Second Affiliated Hospital of Soochow University from September 2021 to November 2022. The patients were randomly assigned to the active rTMS group (n = 15) and the sham rTMS group (n = 15), and received 10HZ rTMS over left DLPFC for 7 consecutive days. A battery of neuropsychological assessments was performed on participants pre-test and post-test, including attention, executive function, memory, language, and visuospatial function. A resting electroencephalograph (EEG) was recorded, and the absolute and relative power of delta, theta, low alpha, high alpha, and beta were compared between the two groups. Follow-up assessments were performed at baseline, 1 week, 4 weeks, and 3 months after rTMS treatment.

Results: Finally, 30 patients completed the follow-up. After 1 week of treatment, compared to baseline, the active group showed significant improvement on the Montreal Cognitive Assessment (MoCA) scale (P = 0.019), Auditory Verbal Fluency Test (AVLT) immediate recall (P = 0.001), AVLT long-delayed recall (P = 0.006), AVLT recognition (P = 0.015) and Boston naming (P = 0.012), while the time of Trail Making Test B (P = 0.022) was decreased. Compared to the sham group, a significant increase in the percentage change of the global relative high alpha power was shown in the active group (P = 0.012). The data showed an increase in the percentage change of the relative high alpha power in the left frontal region (P = 0.041). Moreover, the correlation analysis revealed that the MoCA score was positively correlated with the relative high alpha power (P = 0.004). There was no significant change in the sham group.

Conclusion: High-frequency rTMS over left DLPFC contributes to cognitive improvement in PD-MCI patients and increased relative high alpha power may be associated with cognitive improvement.

Trial registration: This study has been registered at Chinese Clinical Trial Registry (identifier: ChiCTR2000039557). Registered on 31 October 2020.

Objective: To validate the clinical utility of creatinine-to-cystatin C ratio (CCR) as a biomarker for monitoring nusinersen treatment response in Chinese paediatric patients receiving nusinersen monotherapy.

Methods: In this retrospective, single-center study, 33 genetically confirmed 5q-SMA patients (≤ 18 years) treated with intrathecal nusinersen for ≥ 26 months (2020.2-2025.6) were enrolled. Motor function was serially evaluated using the Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), and Hammersmith Infant Neurological Exam Part 2 (HINE-2). Serum biomarkers, such as creatinine (Cr), creatine kinase (CK), and cystatin C, were measured at multiple time points. A linear mixed-effects model (adjusted for age, body mass index, SMA type, and treatment duration) was used to assess the biomarker-function associations.

Results: Ambulant patients and those with four SMN2 copies demonstrated elevated CCR and Cr levels compared to non-ambulant patients and those with three SMN2 copies at baseline. Serum CCR levels were significantly higher than the baseline at V4-V8 (10-26 months). Cr levels were significantly higher than the baseline at V8 (26 months), whereas CK and cystatin C levels remained unchanged. In the fully adjusted linear mixed-effects models, both CCR and Cr were positively associated with HFMSE and RULM scores. However, only CCR remained significant after adjustment. Cystatin C levels were inversely correlated with the HINE-2 scores.

Conclusion: CCR is a promising biomarker in paediatric SMA patients receiving nusinersen monotherapy; however, its validity and generalizability require confirmation in larger, more diverse multicenter cohorts.

Background: Polycythemia vera (PV) is a myeloproliferative neoplasm, characterized by trilineage hypercellularity, which increases the risk of thrombosis. Stiff-person syndrome (SPS) is a very rare autoimmune neuronal excitability disorder, in which antibodies disrupt the balance between excitatory and inhibitory neurotransmitters, leading to stiffness and spasms of agonist and antagonist muscles.

Case presentation: This report describes the first known case of PV and SPS occurring simultaneously in a middle-aged male patient. He presented with back stiffness and painful abdominal spasms and was found to have erythrocytosis incidentally. He had high JAK2 V617F mutation burden and was positive for anti-GAD65 antibody. Progressively intensified therapy was given until his symptoms resolved.

Conclusions: This case highlights the diagnostic and therapeutic challenges of these conditions as well as the need for further exploration of potential shared molecular mechanisms between PV and SPS.

Background: Growing evidence suggests an association between hearing loss and cerebrovascular outcomes. However, the contribution of hearing asymmetry, which may reflect unilateral auditory vulnerability or localized cochlear and neural injury, has received limited attention. This study examined the association between asymmetric hearing loss and incident stroke in a national sample of older adults and evaluated whether this association varied by sex.

Methods: We conducted a prospective cohort study using data from Waves 13 to 15 of the US Health and Retirement Study. The analytic sample included 11,696 adults aged fifty years or older who completed bilateral pure tone audiometry. Hearing status was categorized into normal hearing, symmetrical hearing loss, and asymmetric hearing loss. Incident stroke within two years was identified from self or proxy reported physician diagnoses. Multivariable logistic regression models were used to estimate associations, adjusting for demographic characteristics, socioeconomic factors, lifestyle variables, sensory impairments, and health conditions. Sex stratified analyses and two sensitivity analyses were performed to assess robustness.

Results: Over the two-year follow up period, 182 stroke events were reported. Asymmetric hearing loss was associated with a higher risk of incident stroke compared with normal hearing in fully adjusted models (adjusted OR = 1.69, 95%CI = 1.03 ~ 2.78). Symmetrical hearing loss was not significantly associated with stroke risk after adjustment. In sex stratified models, the association between asymmetric hearing loss and stroke persisted in men, although the confidence interval was wide due to smaller subgroup sample size. No significant associations were observed among women. Sensitivity analyses that further adjusted for self-rated hearing or applied inverse probability weighting produced estimates that were consistent with the primary findings.

Conclusions: Asymmetric hearing loss was associated with incident stroke after adjustment for demographic and health related factors. These findings suggest that hearing asymmetry may reflect vascular vulnerability in older adults and may be a useful indicator in risk assessment strategies.